Based on interviews and record review, it was determined the facility failed to provide the services of a Registered Nurse (RN) at least eight (8) consecutive hours a day, seven (7) days a week from 07/01/2023 through 09/30/2023. The findings include: Review of the facility's policy titled, Staffing Policy, revealed it was the policy of the Center to ensure that sufficient qualified nursing staff were available daily to meet residents needs for nursing care and in a manner and environment which promotes each resident's physical, mental and psycho-social well-being thus enhancing their quality of life. Staffing was determined within the facility based on work assignments designed to meet the needs of residents as determined by the resident assessment and individual plans of care. Review of the facility's July 2023 daily staffing sheets revealed the facility failed to have RN coverage for eight (8) consecutive hours in the facility on 07/01/2023, 07/02/2023, 07/08/2023, 07/09/2023, 07/15/2023, and 07/16/2023. Review of the facility's August 2023 daily staffing sheets dated 08/01/2023 through 08/20/2023, revealed there was documented RN coverage for eight consecutive hours each day. Review of September 2023 daily staffing sheets revealed there was no documented RN coverage on 09/06/2023, 09/07/2023, 09/09/2023, 09/23/2023, and 09/30/2023. In an interview with the Business Office Manager (BOM) on 02/15/2024 at 10:04 AM, she stated she was unaware that the facility had no RN coverage as the Administrator was an RN. The BOM was unaware that the Administrators hours were not reported as direct care hours. In an interview with the Director of Nursing (DON) on 02/15/2023 at 5:58 PM, she stated the facility did not currently have a dedicated RN to work the weekends. She stated she believed resident safety was ensured, as the Administrator was also an RN and lived onsite. In an interview with the Administrator, on 02/15/2024 at 6:15 PM, she stated she was the Administrator but also an RN. She stated she was aware that the facility had days with no RN on duty, but she was an RN and lived onsite. The Administrator stated she was unaware her hours in the facility did not count for the RN coverage. She stated the facility had difficulty with hiring RNs, but the DON was always on call to cover call ins.

Based on observations, interviews, and review of facility documents, it was determined the facility failed to store, label, and date food in accordance with professional standards for food service safety. The findings include: Review of a facility document titled, Labeling and Dating for Safe Storage of Food, dated 04/10/2023, revealed labeling and dating were critical in order to promote food safety. The use of use by dates would be reviewed. All products should be dated upon receipt. All products should be dated when opened, used by dates on all food once opened and stored under refrigeration. Observation of the kitchen on 02/14/2024 at 8:42 AM, revealed walk in cooler #1 contained a plastic container partially full of a brown substance that was not labeled or dated. Further observation revealed a container full of a yellow/orange substance not labeled or dated. Observation of the kitchen on 02/14/2024 at 8:48 AM, revealed walk in cooler #2 contained a tray containing forty-one (41) ten (10) ounce Styrofoam cups of various liquids that were not dated. In an interview with the Certified Dietary Manager on 02/14/2024 at 8:50 AM, she stated the brown substance was caramel sauce and the yellow/orange container was cheese sauce left over from a facility party. She further stated the tray of various liquids were from the supper meal the previous night. The CDM stated she would remove all the items from the coolers because they should be labeled and dated prior to storage.